The cross-fertilization of Western science with ideas from ancient Eastern wisdom systems has been adding scientific legitimacy to the discipline of yoga over the last few decades. Medical professionals and scientists are pursuing yoga-related research, focusing on its potential to prevent, heal, or alleviate specific conditions such as heart disease, high blood pressure, carpal tunnel syndrome, asthma, diabetes, and symptoms of menopause, and its benefits as a technique for relieving stress and coping with chronic conditions or disabilities. Evidence-based publications report on clinical benefits associated with yoga, including reaction time, respiratory endurance, proprioception, and other physiological and psychological effects. Mudras (yoga for the hands) are defined as hand gestures that are historically grounded in the ancient Indian arts and sciences. Referring to gestures or attitude, the science of yoga describes mudras as a means to control or alter the mood by reorienting or focusing the flow of prana (vital spiritual energy) in desired directions or concentrating it at specific places within the body. Modern yoga literature explains Mudras as “seals” or “circuit bypasses” for energy currents. Mudras can be used to improve hand strength and flexibility after injury because they are a simple, portable, enjoyable, and economic exercises and research shows that regular yoga practice can be used to improve overall body strength and flexibility. Some of what is taught by yoga teachers in classes, books and journals defies modern understanding of anatomy and physiology or is grounded in metaphysics that is off-putting or virtually incomprehensible. But now, scientists are able to look at the body and brain with increasing precision, detecting subtle changes that practitioners of yoga and meditation undergo. The majority of scientific research on yoga takes place in India and is very difficult to access in the United States. Because few yoga studies were previously conducted in the West, most American scientists dismissed Indian yoga research due to methodological problems, such as a lack of control groups in the studies. The methodology has improved significantly and it can be argued that currently, many Indian yoga studies are superior to many of those conducted in the West. Given the Western allopathic model, translating the information using the language and perspective of science as much as possible is recommended to demonstrate to physicians and other health care professionals how therapeutic yoga can benefit patients. As yoga moves deeper into the mainstream, and as research dollars for complementary and integrative health systems increase, the number of yoga practitioners and health professionals are increasing. The number of randomized clinical trials is growing as well. Improved study designs are being used both in India and the United States. In just the last few years, research has documented the efficacy of yoga for such conditions as back pain, multiple sclerosis, insomnia, cancer, heart disease, and even tuberculosis. The 2008 “Yoga in America” study shows 15.8 million people currently practice and also revealed an upward trend in the therapeutic medical use of yoga. According to the study, nearly 14 million Americans reported a doctor or therapist recommending yoga to them. Nearly half of all adults agreed that yoga would be a beneficial treatment for a medical condition. “Yoga as medicine represents the next great yoga wave,” says Kaitlin Quistgaard, editor in chief of Yoga Journal. “In the next few years, we will be seeing a lot more yoga in health care settings and more yoga recommended by the medical community as new research shows that yoga is a valuable therapeutic tool for many health conditions.” There are 112 clinical trials utilizing yoga currently listed on the National Institutes of Health web site. These involve numerous medical conditions including arthritis, fibromyalgia, cancer, chronic neck pain, chronic back pain, asthma, kyphosis, etc. The individual trials are being conducted at medical centers across the country and involve thousands of patients. Evidence regarding the medical benefit of yoga shows mixed results. There are several reasons for this, including funding obstacles. The biggest challenge yoga studies face is that given the best intentions, it is difficult to properly ascertain the effectiveness of yoga as an exercise therapy. Yoga is not easily fit into the form of study that is most often used to prove effectiveness, the double-blind, placebo-controlled trial. While it is possible to design a placebo form of study, it would be exceedingly difficult to conceal from participants and researchers the practice of real yoga versus an inauthentic version. It is inevitable that some compromise with the research standards is required, and the compromise used in most studies is not ideal. Oftentimes, the practice of yoga is compared to no treatment. The problem with such studies is that a treatment, any treatment, frequently appears as better than no treatment due to multiple factors. A better trial design would be compare yoga practice to a generic form of exercise, such as daily walking. To date, this design has not been commonly implemented. Hatha yoga has been studied in patients with carpal tunnel syndrome. In one study, forty-two individuals with carpal tunnel syndrome were randomly assigned to receive either yoga instruction or a wrist splint for a period of eight weeks. The results indicated that yoga was more effective than the wrist splint. The study results were soundly criticized due to a serious design flaw as participants in the control group were simply offered the wrist splint and given the choice of using it or not. Critics stated they would have preferred for subjects to have received options such as fake laser acupuncture or phony yoga postures rather than nothing. Experience from numerous studies shows that when people believe they are receiving an effective treatment, they report improvement regardless of the nature of the treatment. The School of Medicine at the University of Pennsylvania used yoga to treat a group of patients with osteoarthritis of the hands. The treated group improved significantly more than the control group in “pain during activity, tenderness, and finger range of motion.” The randomized controlled clinical trial, published in the Journal of Rheumatology in 1994, concluded, “This yoga-derived program was effective in providing relief in hand osteoarthritis. Further studies are needed to compare this with other treatments and to examine long-term effects.” In another small study published in the British Journal of Rheumatology, it was found that a three-month program of gentle asana and breathing techniques resulted in improved grip strength in patients with rheumatoid arthritis. As an interesting note, Robin Monro, PhD, of the London Based Yoga Biomedical Trust found that that all patients wished to continue the practice after the study was finalized. Yoga poses called asanas work by safely stretching muscles. This releases lactic acid that builds up with muscles use and causes stiffness, tension, pain, and fatigue. In addition, yoga increases the range of motion in joints. It may also increase cellular joint lubrication. The outcome is a sense of ease and fluidity throughout the body. Yoga stretches not only muscles, but the body’s soft tissues as well, including ligaments, tendons, and the fascia sheath surrounding muscles. Vigorous exercises and precise alignment poses can provide strength and endurance benefits. Some yoga styles use specific meditation techniques to quiet the constant “mind chatter” that often underlies stress. Other yoga styles use deep breathing techniques to focus the mind on breath. Once focused, the mind settles down and becomes more calm and quiet. Yoga’s anti-stress benefits may include a reduction in catecholamines, the adrenal gland stress hormone. Another benefit of yoga is its unique way of massaging the internal glands and organs of the body in a thorough way, including those such as the prostate gland that are rarely stimulated externally. Massage and stimulation of the organs can serve to prevent and also provide early forewarning of disease. A practicing physician for over twenty years, in his book Yoga as Medicine, David Coulter, MD, says that yoga is the most powerful system of overall health and well-being he has ever seen. He describes it as a single comprehensive system that, among other things, has been shown to increase strength, flexibility, and balance, enhance immune function, lower blood sugar and cholesterol levels, facilitate weight loss, strengthen bones, prevent injuries as well as improve psychological well-being. As the major blockages of physical and energy flows are removed through the practice of yoga asanas, pranayama and bandhas, it is believed that advanced practitioners utilize Mudras to effect extraordinary self-control of prana in the brain and the central nervous system. Swami Satyanand Saraswati observed that “Mudras provide a means to access and influence the unconscious reflexes and primal, instinctive habit patterns that originate in the primitive areas of the brain around the brain stem. They establish a subtle, non-intellectual connection with these areas. Each Mudra sets up a different link and has a correspondingly different effect on the body, mind and prana.” Echoing that concept is a recent study sponsored by the NIH National Institute on Deafness and Other Communication Disorders (NIDCD), in collaboration with the Hofstra University School of Medicine and San Diego State University, which showed sign language being largely processed in the same brain regions as spoken language, including the inferior frontal gyrus in the front left side of the brain and the posterior temporal region toward the back left side of the brain. Dr. Braun believes that developing a better understanding of brain systems supporting gestures and words may also help in the treatment of some patients with aphasia. The palms and fingers of the hands contain an abundance of nerve endings, which continually emit bioelectric energy. Touching or pressing specific points on the fingers and the thumb folded in specific manner activates specific nerve or nerve bundles thus triggering specific signals. This is what makes certain Mudras suitable for enhancing mental and physical effects. The importance of specific points and portions of hand (and other parts of the body) can also be seen in healing effects of acupressure on the physical body. The advanced effects of yoga and of Mudras in particular are associated with mental refinement, deep meditation and spiritual conditioning. Even for beginning practitioners, Mudras utilized as physical exercises can increase manual dexterity and can be effective for stretching and maintaining hand mobility. Exactly when and where systematized and stylized gestures originated remains a mystery, however almost all ancient cultures made use of hand signs in one way or another. Mudras, or hand gestures, were employed in early religion, rhetoric, art, social gatherings and by trade guilds. The Comacines, the builders of Europe’s finest cathedrals, and the trade guild known as the Dionysiac Artificers who were responsible for the construction of ancient buildings and structures, all made use of hand signs as a system of communication and protection of their conclaves or secret meetings against unauthorized entry. In Hinduism and Buddhism, hundreds of Mudras were used in yogic practice for ceremonies, drama, and dance. Most of these were symbolic in nature, but others had metaphysical virtues. There are literally hundreds of Mudra-gestures formed by the ancient yogis and sages. They are all based on four basic hand positions: the open palm, the hollowed palm, the closed fist, and the hand with fingertips together. Cheironomy is the term used to denote the study of ritualistic hand gestures and spontaneous movements in directing vocal music. This primarily refers to esoteric symbolism and certain forms or gestures and signs used in religious rites. The religious ceremonies of many ancient cultures considered gestures vital as they were believed to contain powers to call upon the gods, to unfold powers, and to affect surroundings. In occultism, each hand gesture embodies a particular significance and force. Ancient Egyptians regarded even the pictorial representations of their pharaohs as highly potent. Whether creating statutes or depicting pharaohs in murals, the artists were careful to represent Mudras accurately, fearing harsh consequences for misrepresentation. Mudras also play an important role in the Indian Classical Dance. There are single hand gestures, called “Asamyukta Hastah”, which can be performed by either the right hand only or the left hand only or by both hands simultaneously without combining the two hands. The gestures formed by uniting both hands are called “Samyukta Hastah”. According to the ancient scripture “Abhinaya Darpana” (Nandikeshwara) there are twenty-eight single hand gestures and twenty-four united hand gestures. These hand gestures or Mudras are frequently used in the Indian Classical Dance known as Bharatanatyam. There are Mudras which represent all the Gods and Goddesses (Brahma, Vishnu, Shiva, Saraswati, Lakshmi, etc.), the four different castes (Brahmana, Kshatriya, etc.), different relations (Mother, daughter, etc.), the nine the nine planets (Sun, moon, etc.), rivers (Ganga, Yamuna, etc.), animals (Lion, deer, etc.) and many others. There are numerous publications that identify the clinical benefit of yoga practice for various medical conditions, including oncology, osteoarthritis, and rheumatoid arthritis. However, these publications do not specifically report on the upper extremity sensorimotor, musculoskeletal, or neurophysiological results for hand therapy patients. As hand therapists are becoming more aware of the importance and value of respiration, core body strength, and posture to upper extremity function, the incorporation of hand Mudras could provide an integrated approach that broadens the treatment repertoire. On a tissue-specific level, differential tendon gliding, nerve gliding, and proprioception could be facilitated within a calming and holistic context using Mudras. It is well known that movement distributes lubricating synovial fluid, continually secreted into the joint by its synovial lining, over the surface of the cartilage that caps the bones. When the cartilage is well lubricated, the joint surfaces glide more easily across each other, reducing wear and tear. Joint movement also helps bring nutrients into cartilage, which lacks its own blood supply. Cartilage acts as a sponge that gets squeezed by movement. Stale synovial fluid, depleted of nutrients, is expressed thus allowing a fresh supply to soak in from the joint when the compression is released. Areas of the joint surface that are rarely used because they are outside the normal grooves of movement fail to get the nutrients they need and over time tend to degenerate. The practice of Mudras can be used to stimulate these little-used surfaces, a prime example of the “use it or lose it” theory. Mudra exercises can be individually tailored following injury to target specific muscles for the purpose of reducing stress, increasing range of motion, reducing pain, and increasing flexibility and strength. And experts in therapeutic yoga point out that individualizing a treatment approach is oftentimes vital in achieving a success outcome. In addition to working directly with specific injuries or medical conditions, yoga therapists also emphasize the role in healing that mindfulness and awareness the body plays. It can be been argued that tension held in the body often originates in the mind and must be dealt with there first. It is common knowledge that stress contributes to the development and prolongation of many medical conditions, which in turn can delay healing. Experts have noted that while a complaint may show up, for example, as a wrist disorder, effective treatment requires consideration of the upper extremity and torso as well as the role the mind plays in the condition. As part of medical treatment, Yogic philosophy would take into consideration posture, alignment, communication, and the effects of stress on the disorder. There will probably never be scientific validation for each style of yoga or Mudra practice, much less all the possible combinations. As B.K.S. Iyengar says “Words fail to convey the total value of yoga. It has to be experienced.” Some of yoga’s aims, like equanimity and compassion, are difficult if not impossible to quantify. And while the current scientific evidence is not robust by Western standards, the growing body of evidence that does exist should not be ignored. We must take some of what we know about yoga on faith-not a faith based on blind acceptance of doctrine, but one grounded in everyday experience. Much more research is needed, with studies being designed to take advantage of potentially beneficial interventions. Strategies that maximize compliance among subjects at greater risk for low adherence will be important for future trials, especially complementary treatments requiring greater effort than simple pill-taking. Carefully exploring the vast universe of yogic healing can provide affordable access to compelling new models of balance and wholeness. Taking a new approach, the middle ground between uncontrolled observations and reductionist philosophy may provide overall greater value to patients. In this age of health care reform it becomes imperative to add to the body of knowledge through not only randomized controlled trials, but through studies of screening and diagnostic tools based on Eastern systems of medicine and allied health sciences, outcome studies, cost effectiveness analyses, case-control series, and surveys with high response rate. As a therapeutic modality, yoga continues to show great potential for widespread use. The boundaries are still fluid, however provided that scientists, yoga therapists and physicians continue to communicate and learn from each other, the use of yoga practice and Mudras can expand as an noninvasive and effective means to improve strength and flexibility following injury.
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